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ED Waits Linked to Higher Costs, LOS

John Commins, for HealthLeaders Media, December 7, 2012

Solutions to ED Crowding
Sun says the American College of Emergency Physicians has guidelines that could help hospitals alleviate ED crowding and boarding. He detailed three recommendations "that seem to be very effective although the political will to implement these might be challenging."

1.Manage Flow
For starters, he says there needs to be someone in the hospital whose job is to manage inpatient flow.

"One common name that is given is the bed czar," Sun says. "This is either a physician or a nurse manager who is always monitoring the availability of inpatient beds. This is across all services but usually medicine and surgery are the two major services you have to watch out for."

"This may require the bed czar to know how many patients are getting elective procedures  because those patients are guaranteed to require a bed after the operation. Have one person or a few people who are given the responsibility of knowing what is going on throughout the hospital so they can facilitate through-put, making sure beds are turned over as quickly as possible, making sure of their known bed needs, that the hospital is prepared for that."

2.Spread Out the Boarders
Another solution is to spread the burden of the overcrowded ED throughout the hospital.

"In a lot of the hospitals I've worked at, when the hospital is crowded you just board a bunch of patients in your hallway. You may have multiple patients in stretchers who in theory are admitted, but because there is no place to put them, they just fill up the hallway in the ED," Sun says.

"What's so special about the ED hallways? Spread these patients out throughout the hospital."

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